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Total knee arthroplasty (TKA) rates are increasing among younger patients, who have higher functional demands for return to sport. However, there is limited in-vivo biomechanical data to guide postoperative activity recommendations in this population. The purpose of this study was to define gait kinematics and kinetics in young (S60 years) and older (>60 years) TKA patients compared to healthy controls. We hypothesized that younger TKA patients would demonstrate altered movement patterns associated with increased joint loading. Eighty-eight knees from an institutional biomotion database were analyzed in this retrospective study, including older TKA (n=50), young TKA (n=21), and healthy controls (n=17). All procedures were performed by fellowship-trained surgeons at a single institution. Three-dimensional gait analysis using marker-based motion capture and force plates was conducted to evaluate joint kinematics and kinetics. Statistical Parametric Mapping and Kruskal-Wallis tests were used to compare groups across the gait cycle (a=0.05). Young patients demonstrated substantially higher knee extension moments at initial contact and terminal stance compared to older patients and controls. At initial contact, extension moments in young patients (1.4 + 1.4 %BW-ht) were approximately five times higher than older patients (0.2 + 0.8 %BW-ht) and over four times higher than controls (0.3 + 0.8 %BW-ht; p<0.05). At terminal stance, extension moments in the young group (0.5 + 0.6 %BW-ht) were more than twice those of older patients (0.2 + 0.5 %BW-ht) and five times higher than controls (0.0 + 0.3 %BW-ht; p<0.05). Additionally, young patients demonstrated persistent varus alignment throughout the gait cycle compared to valgus alignment in older patients and controls (p<0.05). These findings suggest that younger TKA patients experience elevated tibiofemoral loading, placing them at greater risk for implant wear, loosening, and revision. Identifying biomechanical risk factors in this high-demand population may inform personalized rehabilitation and surgical decision-making, ultimately improving long-term outcomes.

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University of Illinois Chicago

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